Sexual partners are the primary source of incident HIV infection among adolescent girls and young women (AGYW) in sub-Saharan Africa. Identifying partner types at greatest risk of HIV transmission could guide the design of tailored HIV prevention interventions.
We conducted a secondary analysis of data from AGYW (aged 13–23 years) enrolled in a randomized controlled trial of cash transfers for HIV prevention in South Africa. Annually, AGYW reported behavioral and demographic characteristics of their 3 most recent sexual partners, categorized each partner using prespecified labels, and received HIV testing. We used latent class analysis (LCA) to identify partner types from reported characteristics, and generalized estimating equations to estimate the relationship between both LCA-identified and prespecified partner types and incident HIV infection.
Across 2140 AGYW visits, 1034 AGYW made 2968 partner reports and 63 AGYW acquired HIV infection. We identified 5 LCA partner types, which we named monogamous HIV-negative peer partner; one-time protected in-school peer partner; out-of-school older partner; anonymous out-of-school peer partner; and cohabiting with children in-school peer partner. Compared to AGYW with only monogamous HIV-negative peer partners, AGYW with out-of-school older partners had 2.56 times the annual risk of HIV infection (95% confidence interval: 1.23 to 5.33), whereas AGYW with anonymous out-of-school peer partners had 1.72 times the risk (95% confidence interval: 0.82 to 3.59). Prespecified partner types were not associated with incident HIV.
By identifying meaningful combinations of partner characteristics and predicting the corresponding risk of HIV acquisition among AGYW, LCA-identified partner types may provide new insights for the design of tailored HIV prevention interventions.
aDepartment of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC;
bHIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY;
cDivision of Epidemiology, The Ohio State University, Columbus, OH;
dDepartment of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC;
eCarolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC;
fDepartment of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC;
gDepartment of Biostatistics, University of Washington, Seattle, WA;
hFred Hutchinson Cancer Research Center, Seattle, WA;
iMedical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;
jINDEPTH Network, Accra, Ghana;
kWits Reproductive Health and HIV Research Institute, University of the Witwatersrand, Johannesburg, South Africa;
lSchool of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia; and
mEpidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Correspondence to: Nadia Nguyen, PhD, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, 722 W 168, New York, NY 10032 (e-mail: firstname.lastname@example.org).
Supported by NIH Grants T32MH19139, L60MD013176, T32AI007001, P30MH43520, UM1AI068619, UM1AI068613, and UM1AI1068617. The HIV Prevention Trials Network is funded by the National Institute of Allergy and Infectious Diseases (UM1AI068619, UM1AI068613, and UM1AI1068617), with cofunding from the National Institute of Mental Health and the National Institute on Drug Abuse, all components of the US National Institutes of Health. This work was also supported by NIMH (R01MH087118) and the Carolina Population Center and its NIH Center grant (P2C HD050924). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Presented at CROI 2018; March 5, 2018; Boston, MA.
The authors have no conflicts of interest to disclose.
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Received December 07, 2018
Accepted April 17, 2019
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